BEHAVIORAL HEALTH INTERVENTIONS IN THE HOSPICE SETTING: A SCOPING REVIEW

Abstract Hospice is a model of care for individuals with a life expectancy of less than six months who choose to focus their treatment on quality-of-life rather than extending life. In 2019, half of all Medicare decedents elected to receive hospice care. Behavioral health comorbidities are prevalent in hospice patients; approximately 40% experience significant depression and/or anxiety. Such comorbidities are associated with poor outcomes including increased physical symptoms, worse function, and lower quality-of-life. Despite the impact of behavioral health comorbidities on hospice patient outcomes, little research has focused on the use of behavioral health interventions in the hospice setting. We conducted a scoping review to characterize the types of behavioral health interventions administered to patients receiving hospice care. We searched four databases, generating 6,842 unique citations over any time period. 70 texts were reviewed and 31 were retained for analysis. Studies examined both psychotherapeutic (n=10) and psychopharmacologic (n=10) interventions, as well as other non-pharmacologic interventions (n=11). Duration of study follow-up was available for 17 of the studies, ranging from six days to six months. 14 studies reported information on interventionists, who were most commonly music (n=3) or massage therapists/acupuncturists (n=3). Average interventions were 47 minutes for six sessions. 18 studies presented statistically significant results related to primary outcomes, most commonly depression (n=9), anxiety (n=6), and pain (n=4). Our findings demonstrate a dearth of behavioral health interventions targeting hospice patients, suggesting the need for increased research and clinical focus on developing, evaluating, and implementing behavioral health interventions in the hospice setting.


AN AGENTIC PERSPECTIVE ON AGING PREPARATION
Yaeji Kim-Knauss, and Frieder Lang, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Bayern, Germany When imagining one's future life in old age individuals may respond to an uncertain future with proactive and preparatory activity aiming to maximize possible rewards and minimize risks or costs.The current research applies an agentic perspective on aging preparation that emphasizes the role of individuals' beliefs and attitudes in determining their engagement in actions.The present research aims to investigate the associations between action-related beliefs (perceived utility/ risk) and situational cues (experience/appraisals of agingrelated life challenges) with individuals' engagement in aging preparation.Data comes from the "Ageing as Future" project, which includes multicultural (i.e., Germany, US, Hong Kong, Taiwan, Czechia), longitudinal (i.e., five measurement points spanning from 2012 to 2020), and lifespan data (i.e., aged 18 to 98).Results from a series of analyses indicate that perceiving more utilities, having experience in caregiving, and having health-related worries at the peak of the COVID-19 pandemic were associated with engagement in aging preparation.However, the magnitude of these associations varied depending on the time perspective and cultural context.Findings suggest that individuals engage in aging preparation to attain desirable or to avoid undesirable outcomes in the future based on personal values and belief systems.The dynamic interplay of personal belief systems with temporal and cultural contexts was also highlighted that differently shapes individual's agentic engagement in aging preparation.

BEHAVIORAL HEALTH INTERVENTIONS IN THE HOSPICE SETTING: A SCOPING REVIEW
Lilla Brody 1 , Karolina Sadowska 2 , Alexis Holllingsworth 3 , Michael Ong 3 , Tejas Subramanian 4 , Drew Wright 3 , M. Cary Reid 2 , and Daniel Shalev 2 , 1. Weill Cornell Medicine,Washington,District of Columbia,United States,2. Weill Cornell Medicine,New York City,New York,United States,3. Weill Cornell Medical College,New York City,New York,United States,4. Weill Cornell,New York City,New York,United States Hospice is a model of care for individuals with a life expectancy of less than six months who choose to focus their treatment on quality-of-life rather than extending life.In 2019, half of all Medicare decedents elected to receive hospice care.Behavioral health comorbidities are prevalent in hospice patients; approximately 40% experience significant depression and/or anxiety.Such comorbidities are associated with poor outcomes including increased physical symptoms, worse function, and lower quality-of-life.Despite the impact of behavioral health comorbidities on hospice patient outcomes, little research has focused on the use of behavioral health interventions in the hospice setting.We conducted a scoping review to characterize the types of behavioral health interventions administered to patients receiving hospice care.We searched four databases, generating 6,842 unique citations over any time period.70 texts were reviewed and 31 were retained for analysis.Studies examined both psychotherapeutic (n=10) and psychopharmacologic (n=10) interventions, as well as other non-pharmacologic interventions (n=11).Duration of study follow-up was available for 17 of the studies, ranging from six days to six months.14 studies reported information on interventionists, who were most commonly music (n=3) or massage therapists/acupuncturists (n=3).Average interventions were 47 minutes for six sessions.18 studies presented statistically significant results related to primary outcomes, most commonly depression (n=9), anxiety (n=6), and pain (n=4 The study used negative binomial regression to analyze three waves (2014, 2016, and 2018) from HRS (n=1,991).Results: African Americans were found to stay longer in hospice than their White counterparts when controlling for all other variables in the model.Not married, having Medicare insurance, cancer, chronic lung disease, and dementia significantly influence length of hospice stay when holding all other variables constant in the model.Discussion: The significant Black/ White differences in hospice length of stay demonstrate the potential decrease in cumulative inequality in the delivery of appropriate and needed hospice services across the two racial groups.Future research is recommended to explore the potential consequences of longer hospice stays as well as the health and health care mechanisms related to the different disease profiles that lead individuals to hospice care, especially among African Americans.

DECISION MAKING ABOUT LIFE-SUSTAINING TREATMENT FOR UNREPRESENTED ADULTS IN KOREAN HOSPITALS
Hyejin Kim 1 , Jiyeon Choi 2 , Won Lee 1 , Ilhak Lee 2 , and Mi-Kyung Song 3 , 1. Chung-Ang University, Seoul, Republic of Korea,2. Yonsei University,Seoul,Republic of Korea,3. Emory University,Atlanta,Georgia,United States BACKGROUND: In South Korea, unrepresented adults are individuals who lack decision-making capacity, written treatment preferences, and available immediate family.Since the enactment of the Life-Sustaining Treatment Decision Act in 2018, ethical and legal dilemmas surrounding decision-making about life-sustaining treatments for unrepresented patients have emerged among healthcare providers in hospitals.Thus, the objectives of this qualitative descriptive study were to explore decision-making practices about life-sustaining treatments for unrepresented patients.
METHODS: We interviewed 37 healthcare providers including physicians, nurses, and social workers from 22 hospitals in South Korea, and analyzed the interview data using a directed content analytic technique.RESULTS: Healthcare providers reported a lack of decision-making guidelines regarding life-sustaining treatments for unrepresented patients in their institutions or being uncertain about the presence of such guidelines.Physicians primarily make decisions about life-sustaining treatments for these patients.Ethics committees' involvement in such decision-making is minimal in most hospitals.Basic life-sustaining treatments are usually initiated if necessary.However, life-sustaining treatments unrepresented patients are currently receiving cannot be discontinued even though those treatments seem pointless.Thus, additional life-sustaining treatments (e.g., extracorporeal membrane oxygenation) tend to be withheld.Important considerations in the decision-making process include the person's reversibility, risk of adverse events, and medical costs.CONCLUSION: Decision-making about life-sustaining treatments for unrepresented patients is currently in legally blind spots in South Korea.Reforms in regulations and policies surrounding such decision-making practices for unrepresented patients and the development of institutional guidelines are urgently necessary to improve decision-making practices about life-sustaining treatments for these individuals.Hypochondriasis -or illness anxiety disorder -is the preoccupation of having an illness, which has been linked with and theorized to be caused by fear of death.While death anxiety tends to decrease with age because of increased exposure to death, the association between illness anxiety and fear of death strengthens with age.Many anxiety disorders, including illness anxiety disorder, have often been explained by an intolerance for uncertainty.The current study therefore investigated whether intolerance of uncertainty mediated the effect of fear of death on hypochondriasis among older adults.Older adults (N = 260), ages 65 to 94 years (M = 75.8,SD = 7.39), responded to an online survey, which included the Death Attitude Profile-Revised questionnaire, the Intolerance of Uncertainty Scale, and the Illness Attitudes Scale.Results showed that fear of death was directly related to hypochondriasis as well as indirectly related through intolerance of uncertainty.Fear of death and intolerance of uncertainty were both positively associated with hypochondriasis.Older adults with more fear about death are more likely to experience illness anxiety and have a higher intolerance for uncertainty.It may be that older adults with higher levels of intolerance to uncertainty are more at risk for anxiety, which then may result in increased fear of death and illness anxiety with the increased exposure to death that is associated with older age.Hypochondriasis in older adulthood may therefore be best addressed by interventions that explore the uncertainty of death and focus on increasing tolerance for uncertainty.

DIFFERENCES IN LENGTH OF STAY IN HOSPICE AMONG MIDDLE-AGED AND OLDER ADULTS IN THE UNITED STATES Heshuo
).Our findings demonstrate a dearth of behavioral health interventions targeting hospice patients, suggesting the need for increased research and clinical focus on developing, evaluating, and implementing behavioral health interventions in the hospice setting.Yu 1 , and J. Scott Brown 2 , 1. Miami University in Oxford, Oxford, Ohio, United States, 2. Miami University, Oxford, Ohio, United States Objectives: Hospice length of stay (LOS) is a crucial measure of hospice care.This topic is understudied within a nationally-representative sample across different races/ethnicities, especially among non-White decedents.Methods: